Average Prenatal Care Cost & How Health Insurance Covers It
During a normal pregnancy, women typically get seven to twelve prenatal checkups. They may have considerably greater complications if any complications emerge.
Your obstetrician's fee for each appointment could range from $90 to more than $500. Additional services, such as pregnancy ultrasounds and laboratory testing, are normally invoiced individually and can cost up to $100 per test. Special tests, such as amniocentesis, might cost more than $2,500.
Your actual out-of-pocket cost will vary depending on whether you have health insurance and whether the prenatal treatment is considered routine or diagnostic. There are some expenses that pregnant mothers must bear on their own.
For example, under the terms of your insurance plan, any visit that goes beyond the routine and becomes diagnostic may be subject to cost sharing. Also, your insurance may ask you to pay for some seemingly normal services, such as bloodwork, obstetric ultrasounds, or not-for-profit prenatal testing.
Those without health insurance must pay the whole cost of their prenatal treatment, but there is some good news for those who do. All qualifying health insurance plans are required by the Affordable Care Act to cover regular prenatal care with no cost sharing. That means no copays or coinsurance, and the appointments are totally covered even if you have an unmet deductible.
How health insurance covers the cost of your prenatal visits
Preconception counseling is one of the therapies covered by the Affordable Care Act with no cost sharing if you have health insurance. Even before you conceive, you should see your doctor or gynecologist for a baseline checkup and to ask any questions you may have about your pregnancy plans.
This is an excellent time to consult with your doctor about the best prenatal vitamins for you, particularly folic acid pills, which are advised for all women who may get pregnant because they can help avoid birth defects such as spina bifida and anencephaly. If you have insurance, make sure you receive a prescription from your doctor for your prenatal vitamins because your insurer will pay for certain of them completely. You will not be compensated if you simply take them off the shelf (and they are accessible over the counter).
Prenatal care includes a wide range of procedures, tests, and exams that are paid differently depending on whether they are considered routine or diagnostic.
The cost of routine prenatal visits vs. diagnostic visits
Your doctor will monitor your and your baby's health throughout prenatal visits. They will most likely examine your urine, blood pressure, weight, and fetal heart rate. Your doctor will also measure your abdomen and feel for the baby's position as your pregnancy advances. If you have health insurance, your health insurance plan should cover all of your usual prenatal treatment at no cost to you.
If the obstetrician notices anything odd during the exam, or if you bring up a complaint that necessitates more examination, such as unusual pain or bleeding, the billing code for your visit may shift from routine to diagnostic because the doctor needs to figure out what's wrong. They may need to order more tests. This diagnostic prenatal care is typically not required to be covered by insurance and does not require any cost sharing. Depending on the type of your health insurance plan, you may be responsible for copays, coinsurance, or payments toward your deductible.
The cost of routine screening tests during pregnancy
Certain particular screening tests for pregnant women are required by the health care law to be offered by insurance plans with no cost sharing. These will typically be performed as part of your regularly planned prenatal checkups, and will frequently involve blood work or urine testing. Your health insurance plan's free routine screening tests should include, but are not limited to:
- Anemia testing
- Screening for bacteriuria, urinary tract infection, or other infections
- Screening for Rh incompatibility and follow-up testing for high-risk women
- At your first prenatal visit, you will be screened for Hepatitis B.
- When you are 24 to 28 weeks pregnant, or if you are at high risk of having this condition, you should have a gestational diabetes screening.
- Syphilis testing
You can also access the screenings and services that are available to all women, such as tests for HPV, cervical cancer, HIV, gonorrhea, and chlamydia, as well as counseling for issues like domestic violence and tobacco use, which are fully covered.
Screening tests that aren't mandated by the Affordable Care Act may require you to pay out-of-pocket, depending on your insurance plan's cost-sharing structure.
If you have a healthy pregnancy with no complaints or issues, you may be eligible for free prenatal care if you have a good insurance plan and stay within your network. Everyone else will most likely have out-of-pocket expenses, such as copays or coinsurance for bloodwork or ultrasounds, or even the full cost of different tests up to your deductible. Furthermore, most new parents can anticipate a large payment for labor and delivery.
Prenatal care without health insurance
If you're pregnant and don't have health insurance, now is a great opportunity to find out if you can acquire it. Pregnancy is a regular occurrence, but it is also extremely expensive. According to a 2013 Truven Health Analytics Marketscan Study, the average cost of having a baby in 2010 was almost $30,000, which included prenatal care, vaginal birth, and the first three months of newborn medical care. It was around $50,000 for cesarean sections (commonly known as C-sections).
If you don't have health insurance through your employment or your parents, consider purchasing an individual policy through your state's marketplace or the federal exchange. Unless you have a qualifying event, like losing your insurance, relocating to a new state, or getting married, you can only sign up for coverage during the open enrollment period.
- Be aware that becoming pregnant does not qualify you for health insurance. Consumer groups and federal senators have been urging the addition of a specific enrollment time for pregnant women in order to secure their access to prenatal care. Opponents are concerned that this may encourage women to delay getting insurance until they need it for pregnancy-related expenses.
Medicaid or a state-sponsored program is one option for many expectant mothers. Many states relax their income restrictions for pregnant women in order to provide them with free health insurance.
Even if you don't have health insurance, you should obtain prenatal care for your own and your baby's benefit. Children born to mothers who did not receive prenatal care are five times more likely to die than children born to mothers who went to the doctor on a regular basis while pregnant. Mothers are three to four times more likely to die if they do not receive this critical medical care.